Outcomes with Catheter-Directed Thrombolysis versus Mechanical Thrombectomy for Patients with Intermediate/High Risk Pulmonary Embolism: A Meta-Analysis of 24,090 Patients.
Mohamed Saad Sayed, Doaa Mohamed Gebaly, Hasan Ilyas et al.
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In 30 seconds
This meta-analysis compared catheter-directed thrombolysis (CDT) with mechanical thrombectomy (MT) in patients with intermediate- or high-risk pulmonary embolism treated with catheter-based therapies. It included 18 studies and 24,090 patients. Mortality and major bleeding did not differ statistically between groups; CDT was associated with a longer ICU stay than MT (mean difference: 1.01 days, 95% confidence interval [CI] 0.87-1.15). Other reported clinical outcomes were also similar. The authors note that larger, well-designed randomised trials are needed to confirm these findings.
Key findings
- CDT was associated with a longer ICU stay than MT (mean difference: 1.01 days, 95% confidence interval [CI] 0.87-1.15).
- All-cause mortality did not differ statistically between CDT and MT (risk ratio [RR] 0.88, 95% CI 0.76-1.01, p = 0.068).
- Major bleeding did not differ statistically between CDT and MT (RR 1.07, 95% CI 0.74-1.55, p = 0.705).
- Readmissions, transfusions, hospital stay, cardiac arrest, and stroke were reported as similar between groups.
Why it matters
For intermediate- or high-risk pulmonary embolism managed with catheter-based treatment, this synthesis found no clear difference between CDT and MT in mortality, major bleeding, or several other clinical outcomes. The longer ICU stay associated with CDT is a relevant resource-use finding, but the evidence does not establish superiority of either approach. Randomised comparisons are needed to clarify comparative outcomes.
What to keep in mind
The analysis included studies rather than being a randomised comparison; the abstract notes that randomised trials are limited and calls for larger, well-designed trials.